Specialist physiatric clinic

An examination by our specialist physiatrist includes:

– A targeted medical history, clinical check-up and functional diagnosis of the musculoskeletal system. Upon appropriate indication, also an ultrasound of the joint or muscles concerned.
– Assessment and evaluation of the rehabilitation potential.
– A referral to the necessary diagnostic examinations to identify any morphological or structural changes.
– The preparation of a rehabilitation plan and the prescription of appropriate physiotherapy carried out by other rehabilitation team providers.
– Our goal is for a person to achieve optimum function and independence. In older people, we maintain their remaining functions and ease pain. In some cases, we regenerate structures using recent infiltration techniques.
– We prescribe analgesic, anti-inflammatory and muscle-toning medication, etc.
– We perform punctures and blocks when necessary and upon appropriate indications.
– We prescribe medical and technical devices with secondary level authorisation under the HIIS Rules.
– We cooperate with specialists from related medical disciplines and refer patients to other specialists when appropriate.
– Education of the patient as well as promotion of a healthy lifestyle and the importance of preventive measures against the deterioration of a condition.

The ultrasound examination of the musculoskeletal system is an important diagnostic method in physical medicine and rehabilitation. The advantages of this examination are its convenience, low cost, repeatability, dynamism, non-invasiveness and harmlessness. A high-quality examination is guaranteed mainly by the specialist’s skill and experience and by the device’s quality. There are no contraindications to ultrasound examinations.
The major technical shortcomings are the ultrasound’s inability to penetrate bones and its prominent reflection in joint prostheses or osteosyntheses where structures cannot be assessed.
We do not examine the spine because the vertebrae and nearby structures are difficult to discern by ultrasound.
Because of its advantages, ultrasound has become the method of choice for the initial diagnosis of disorders of the muscles, tendons, ligaments and joints.
Tendons can have degenerative changes (tendinosis) with or without calcium crystals. We can establish different stages of tendon lacerations (partial, full) or the inflammation of tendon sheaths (tenosynovitis).
We can also detect injuries and changes of articular ligaments.
In a joint, we can demonstrate effusions, inflammatory changes, crystal depositions, surface cartilage erosion and ossein erosion.
We can assess soft tissue oedema (bursitis, haematomas, tumours).
We can visualise the consequences of injuries in the muscles (strains, contusions, lacerations).
We can visualise inflammatory changes or fractures on the bone surface in or outside the joints.
We follow standard protocols to examine individual parts of the body: the shoulder, the elbow, the wrist, the hip, the knee and the ankle.
It is difficult to diagnose damaged cartilage in a joint, injured cruciate ligaments in the knee and generally all those structures set deeply in the joint.
The examination of one joint or area takes from 10 to 20 minutes, depending on whether the injury or change is simple or more complex.
No preliminary preparations are needed for soft tissue examinations, which are painless.
Ultrasound examinations of the musculoskeletal system are carried out by our physical medicine and rehabilitation specialist (a physiatrist) in the Fiziatrija Clinic.
Ultrasound exams enable a more accurate and prompter course of the patient’s treatment and the prescription of the appropriate physiotherapy or rehabilitation.
Moreover, ultrasound is used to supervise therapeutic procedures (punctures, aspiration, injections of medication).
We also use ultrasound examinations to monitor and control the effects of therapy and treatment.

Prolotherapy is a non-surgical infiltration technique used in the treatment of chronic joint pain. It is effective in tendons or ligaments that are damaged and have degenerative changes. 15% or 25% glucose is used together with lidocaine. By infiltrating natural substances, we simulate the regeneration of the tissues and self-healing. From three to six infiltrations are necessary in 4- to 6-week intervals.

Collagen injection biotherapy is a recent medical therapy which stimulates collagen in the subcutaneous tissue and contains natural substances. It is used in the treatment of overstraining syndromes, the ageing process of joints and chronic post-traumatic inflammation. These conditions involve collagen deficiency. Periarticular intradermal injections are applied around the joint, thus improving its functionality and relieving pain. No side effects have been proved for this therapy.

Hyaluronic acid (hyaluronan) is a major component of synovial fluid. It has a significant impact on cartilage elasticity and strain of the joint surface. The main physiological functions of hyaluronan in the knee joint are the following: lubrication of the knee joint and protection of cartilage, shock absorption and pain relief, and enabling quick motion with little friction in the joint. Ampoules with lower molecular weight (Hyalgan) are suitable for younger people with initial degenerative changes of the knees. Ampoules with higher molecular weight (Hyalubrix) are suitable for medium degenerative changes. Hymovis ampoules are indicated for very advanced degenerative changes of the knees. Hyalgan 20 or Hyalubrix 30 is applied into your knee joint three times at weekly intervals. Hyalubrix 60 is applied once. Hymovis ampoules are applied twice at weekly intervals.

Calcification and its related pain in the shoulder are effectively treated with a non-surgical procedure, i.e. an ultrasound-guided shoulder puncture, a globally well-established method. The procedure takes from 20 to 40 minutes, depending on the size and hardness of the calcification. The calcification is accurately punctured under ultrasound supervision and the crystals are washed out. Over 80% of the calcification can be washed out. In most patients, there is no need to repeat the procedure. Only 20% of patients experience milder pain within 3 to 6 months, so the condition has to be verified with an ultrasound.MAKE AN APPOINTMENT

Dry needling, or Western acupuncture, is a technique used to relieve myofascial trigger points using very fine needles. Trigger points are very sensitive points in our muscles, which hurt when pressed and when the muscle in which they are located is activated. First, we palpate the skin to identify the spot of the trigger point responsible for a pain syndrome. Then, we insert a needle through the skin and deactivate active trigger points thus reducing pain. This technique relies upon contemporary knowledge of neuroanatomy and its positive effects have been scientifically proven.